[Prevalence of infections in nursing homes in the Vercelli area (Piemonte, Italy)]

Luigina Gross, Antonella Barbieri, Lidia Carnevale
Igiene e Sanità Pubblica 2012, 68 (1): 29-48

UNLABELLED: The frequency of infections in nursing homes is similar to that found in acute care hospitals: infectious complications are reported in 5-10% of hospitalized patients and 5-16% of nursing home residents. In Italy, the prevalence of infections in nursing homes ranges from 2.7% to 32.7%.The main objective of this study was to estimate the prevalence of acquired infections in nursing homes located in the territory of the Vercelli (VC) local health unit in northern Italy. We also aimed to assess which were the most frequently prescribed antibiotics among the nursing home guests, the reasons for antibiotics prescriptions, whether their use is supported by appropriate microbiological tests, the most common types of microorganisms isolated and the prevalence of antimicrobial resistance.

METHODS: the survey was conducted from 1 July to 31 August 2010 in 14 publicly-funded nursing homes in the VC local health unit. Data for each nursing home were collected in a single day. A modified version of the "Healthcare-Associated Infections in European Long-Term care Facilities" questionnaire was used. Only subjects living in the nursing homes for more than 24 hours, who had signs or symptoms of infection or who were being treated with an antibiotic and who gave informed consent, were included in the study. Multiple linear regression models were used to assess the effects of independent variables on the risk of infection.

RESULTS: the study population consisted of 450 subjects, 46% of whom aged over 85 years, 24% male and 88% living in a nursing home since more than one year. The overall prevalence of infection on the day of the study was 25.5%. Acquired infections were more prevalent among bedridden and wheelchair-bound guests, those who had undergone invasive procedures and those affected by decubitus ulcers. Thirty-two percent of subjects were using antibiotics. Fluoroquinolones were the most frequently used antibiotics and the most frequent reason for antibiotic use was respiratory tract infection followed by urinary tract infection. In 21% of cases no indication for antibiotic use was identified. 12.5% of E coli strains isolated by urine culture were resistant as were 100% of Klebsiella pneumoniae.

CONCLUSIONS: the data highlight a high prevalence of infections in nursing homes in Vercelli as well as worryingly elevated frequencies of antibiotic prescriptions and resistance.

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